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The undersigned hereby applies for the extension of credit on open account from Mullen Publications, Inc., and agrees to MPI's Terms and Conditions of Sale, by supplying the following information:
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Contact
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Company
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Address
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City
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State & Zip
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Email address
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Deliver material to: (if different from above)
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Name
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Address
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City, State, Zip
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Complete the following in full:
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Corporation Partnership Individual
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E.I.N. or
Social Security #:
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Customer contact
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Telephone
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Business description
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How long in business
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Number of employees
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Principals or Officers in Business:
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Name 1
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Address
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Title
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Name 2
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Address
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Title
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Name 3
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Address
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Title
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Who will be
responsible for debt
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Is your company
tax-exempt?
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Yes No
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If 'yes', it is MANDATORY that you fill out, sign and mail to us N.C. Dept. of Revenue Form E-590, Certificate of Resale.
Click here to download Form E-590.
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If 'yes,'
tax emempt number:
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Does your accounting department require a
purchase order number before processing invoices?
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Yes No
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List three companies with whom you have established credit:
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Name
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Address
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City, State & Zip
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Phone
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Name
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Address
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City, State & Zip
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Phone
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Name
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Address
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City, State & Zip
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Phone
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